If you’re living with ulcerative colitis (UC), managing flares is often a key part of your care plan. While lifestyle changes and other first-line treatments may help manage inflammation, many people need a faster, stronger option to get their symptoms under control during a severe flare. That’s where steroids, also known as corticosteroids, come into play.
Steroids are powerful anti-inflammatory drugs that are easy to dispense, inexpensive, come in a variety of formats, and work quickly to calm an overactive immune system, helping to ease UC symptoms such as abdominal pain, cramping, diarrhea, and bloody stools (poop). But bear in mind that they can also come with serious side effects, which is why they’re typically reserved for short-term use only.
Steroids aren’t the first-line treatment for UC, but they can come in handy as a temporary solution in urgent scenarios when someone is having a severe flare-up and needs a fast-acting treatment, says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and professor of gastroenterology at Tufts University in Massachusetts, where she treats people with inflammatory bowel disease (IBD) and other digestive health issues.
“For people with UC, [steroids] can quickly help calm the immune system during a flare and reduce inflammation in the colon,” she says. “Steroids help to ease symptoms like urgency, bleeding and belly pain — this really helps for those in crisis mode.”
They also kick in much faster than long-term therapies that can take weeks or months to take effect, says Sunanda Kane, MD, a professor of medicine in the department of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota.
“They work quickly — within a day or two — and are inexpensive. They can be prescribed by [any doctor] and can be picked up at a local pharmacy without too much trouble,” Dr. Kane says. According to Dr. Rao, they’re typically prescribed in the following scenarios:
During a severe flare-up. In cases of acute, severe UC, corticosteroids may be administered quickly to help reduce symptoms and avoid hospitalization or surgery.
When other medications aren’t working. If UC medications such as immunomodulators or biologics aren’t enough to control inflammation, steroids may be introduced to bring a flare under control as doctors adjust the overall treatment plan.
Before starting maintenance therapy. Steroids can be used as a “bridge” to control inflammation while waiting for longer-term medications such as immunomodulators or biologics to take effect.
“I typically use steroids as a temporary treatment to allow time to initiate long-term disease-modifying therapies, since those tend to have a slower onset of action,” says Laura Sahyoun, MD, a gastroenterologist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, where she treats people with IBD. “This is important when symptoms are negatively impacting people’s quality of life, given increases in stool frequency, urgency, or rectal bleeding,” she says.
There are several formulations of steroids you can take, each with a slightly different way of getting the medication into your body. The kind of steroid therapy your doctor prescribes will be based on the severity of your flare and the location of the symptoms in your body. They include:
Oral Steroids for Ulcerative Colitis
Oral steroids come in pill form and are usually taken with food to help protect the stomach. They include:
Prednisone: This is the most commonly prescribed steroid, Dr. Sahyoun says. It doesn’t target a specific part of the body, but rather acts systemically (affecting the entire body), which can be most effective if someone is feeling inflammation throughout the body. “The benefit of this is that it is more potent and can have a more rapid onset of action. When symptoms are more severe, I prefer to use prednisone,” she says.
Budesonide: Budesonide-MMX is the main formulation of the steroid budesonide that’s indicated by the U.S. Food and Drug Administration to treat UC. Budesonide drugs have a coating, and in the case of UC, this protects the medication until it reaches the colon. That way, the steroid helps treat inflammation limited to the anus and rectum.
Rectal Steroids for Ulcerative Colitis
Rectal steroid formulas typically come in either enema or suppository form (meaning the medication is inserted as a solution or pill into the rectum through a small tube). They’re used in combination with other treatments to help manage UC symptoms affecting digestive health, specifically rectal bleeding and tenesmus (the painful sensation of needing to have a bowel movement), says Rao.
“Suppositories can be helpful when the inflammation is localized in the rectum or lower colon. I try to target the delivery based on where the inflammation is,” she says. Options include:
Suppositories, including hydrocortisone: These reduce rectal inflammation and cut the urgency and frequency of bowel movements. But long-term use may result in the weakening of muscles in the rectum and anus.
Enemas, including hydrocortisone and methylprednisolone: These help treat inflammation in areas above the rectum that cannot be reached by suppositories.
Rectal foams, including hydrocortisone: These are designed to distribute the drug throughout the rectum and colon, and to help it stay inside the rectum (rather than leaking out).
IV Steroids for Ulcerative Colitis
Your gastroenterologist may administer steroids intravenously (IV), especially during severe flares that lead to emergency room visits, says Sahyoun. “If someone is hospitalized for an IBD flare, then we use IV steroids such as methylprednisolone, given that symptoms are severe enough to lead to a hospital stay,” she says.
Steroids are a temporary solution meant to calm symptoms during an urgent flare. They aren’t used as a long-term treatment because they come with so many potential side effects, including:
Mood swings, memory problems, and other psychological effects such as confusion
Fluid retention that leads to swelling in the lower legs
Difficulty falling asleep or staying asleep (insomnia)
Due to the potential side effects of steroid therapy, gastroenterologists usually won’t prescribe them for longer than a few weeks to two months, says Sahyoun. “The course of steroids can be as short as two days to sometimes a slightly extended duration of four to eight weeks,” she says. After that, the dosage is decreased to prevent withdrawal.
When steroids are prescribed, it’s always with a clear “exit strategy” up front for the individual with UC, Rao says. “The real focus is what comes next. The goal is always to transition patients to a maintenance therapy — whether that’s a biologic, immunomodulator, or another targeted treatment. We want remission without relying on steroids,” she says.
One study of people with IBD who used steroids for longer than three months showed that they had an increased risk of lengthy hospital stays and infections, such as upper respiratory tract infections, acute bronchitis, skin infections, urinary tract infections, and pneumonia.
Steroids can offer fast relief during severe ulcerative colitis flares, helping to quickly reduce inflammation and ease symptoms when other treatments haven’t yet taken effect or need to be readjusted.
They’re a short-term solution with a lengthy list of side effects, which is why they’re typically used as a bridge to more sustainable maintenance therapies such as biologics or immunomodulators.
They shouldn’t be taken for more than a few weeks to two months at most.
The side effects of steroids can be serious, so it’s important to follow your doctor’s instructions closely and taper off gradually with your doctor’s guidance.
